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Association between acute kidney injury and norepinephrine use following cardiac surgery: a retrospective propensity score-weighted analysis

BACKGROUND: Excess exposure to norepinephrine can compromise microcirculation and organ function. We aimed to assess the association between norepinephrine exposure and acute kidney injury (AKI) and intensive care unit (ICU) mortality after cardiac surgery. METHODS: This retrospective observational...

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Autores principales: Huette, Pierre, Moussa, Mouhamed Djahoum, Beyls, Christophe, Guinot, Pierre-Grégoire, Guilbart, Mathieu, Besserve, Patricia, Bouhlal, Mehdi, Mounjid, Sarah, Dupont, Hervé, Mahjoub, Yazine, Michaud, Audrey, Abou-Arab, Osama
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9250911/
https://www.ncbi.nlm.nih.gov/pubmed/35781575
http://dx.doi.org/10.1186/s13613-022-01037-1
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author Huette, Pierre
Moussa, Mouhamed Djahoum
Beyls, Christophe
Guinot, Pierre-Grégoire
Guilbart, Mathieu
Besserve, Patricia
Bouhlal, Mehdi
Mounjid, Sarah
Dupont, Hervé
Mahjoub, Yazine
Michaud, Audrey
Abou-Arab, Osama
author_facet Huette, Pierre
Moussa, Mouhamed Djahoum
Beyls, Christophe
Guinot, Pierre-Grégoire
Guilbart, Mathieu
Besserve, Patricia
Bouhlal, Mehdi
Mounjid, Sarah
Dupont, Hervé
Mahjoub, Yazine
Michaud, Audrey
Abou-Arab, Osama
author_sort Huette, Pierre
collection PubMed
description BACKGROUND: Excess exposure to norepinephrine can compromise microcirculation and organ function. We aimed to assess the association between norepinephrine exposure and acute kidney injury (AKI) and intensive care unit (ICU) mortality after cardiac surgery. METHODS: This retrospective observational study included adult patients who underwent cardiac surgery under cardiopulmonary bypass from January 1, 2008, to December 31, 2017, at the Amiens University Hospital in France. The primary exposure variable was postoperative norepinephrine during the ICU stay and the primary endpoint was the presence of AKI. The secondary endpoint was in-ICU mortality. As the cohort was nonrandom, inverse probability weighting (IPW) derived from propensity scores was used to reduce imbalances in the pre- and intra-operative characteristics. RESULTS: Among a population of 5053 patients, 1605 (32%) were exposed to norepinephrine following cardiac surgery. Before weighting, the prevalence of AKI was 25% and ICU mortality 10% for patients exposed to norepinephrine. Exposure to norepinephrine was estimated to be significantly associated with AKI by a factor of 1.95 (95% confidence interval, 1.63–2.34%; P < 0.001) in the IPW cohort and with in-ICU mortality by a factor of 1.54 (95% confidence interval, 1.19–1.99%; P < 0.001). CONCLUSION: Norepinephrine was associated with AKI and in-ICU mortality following cardiac surgery. While these results discourage norepinephrine use for vasoplegic syndrome in cardiac surgery, prospective investigations are needed to substantiate findings and to suggest alternative strategies for organ protection. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13613-022-01037-1.
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spelling pubmed-92509112022-07-05 Association between acute kidney injury and norepinephrine use following cardiac surgery: a retrospective propensity score-weighted analysis Huette, Pierre Moussa, Mouhamed Djahoum Beyls, Christophe Guinot, Pierre-Grégoire Guilbart, Mathieu Besserve, Patricia Bouhlal, Mehdi Mounjid, Sarah Dupont, Hervé Mahjoub, Yazine Michaud, Audrey Abou-Arab, Osama Ann Intensive Care Research BACKGROUND: Excess exposure to norepinephrine can compromise microcirculation and organ function. We aimed to assess the association between norepinephrine exposure and acute kidney injury (AKI) and intensive care unit (ICU) mortality after cardiac surgery. METHODS: This retrospective observational study included adult patients who underwent cardiac surgery under cardiopulmonary bypass from January 1, 2008, to December 31, 2017, at the Amiens University Hospital in France. The primary exposure variable was postoperative norepinephrine during the ICU stay and the primary endpoint was the presence of AKI. The secondary endpoint was in-ICU mortality. As the cohort was nonrandom, inverse probability weighting (IPW) derived from propensity scores was used to reduce imbalances in the pre- and intra-operative characteristics. RESULTS: Among a population of 5053 patients, 1605 (32%) were exposed to norepinephrine following cardiac surgery. Before weighting, the prevalence of AKI was 25% and ICU mortality 10% for patients exposed to norepinephrine. Exposure to norepinephrine was estimated to be significantly associated with AKI by a factor of 1.95 (95% confidence interval, 1.63–2.34%; P < 0.001) in the IPW cohort and with in-ICU mortality by a factor of 1.54 (95% confidence interval, 1.19–1.99%; P < 0.001). CONCLUSION: Norepinephrine was associated with AKI and in-ICU mortality following cardiac surgery. While these results discourage norepinephrine use for vasoplegic syndrome in cardiac surgery, prospective investigations are needed to substantiate findings and to suggest alternative strategies for organ protection. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13613-022-01037-1. Springer International Publishing 2022-07-04 /pmc/articles/PMC9250911/ /pubmed/35781575 http://dx.doi.org/10.1186/s13613-022-01037-1 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Research
Huette, Pierre
Moussa, Mouhamed Djahoum
Beyls, Christophe
Guinot, Pierre-Grégoire
Guilbart, Mathieu
Besserve, Patricia
Bouhlal, Mehdi
Mounjid, Sarah
Dupont, Hervé
Mahjoub, Yazine
Michaud, Audrey
Abou-Arab, Osama
Association between acute kidney injury and norepinephrine use following cardiac surgery: a retrospective propensity score-weighted analysis
title Association between acute kidney injury and norepinephrine use following cardiac surgery: a retrospective propensity score-weighted analysis
title_full Association between acute kidney injury and norepinephrine use following cardiac surgery: a retrospective propensity score-weighted analysis
title_fullStr Association between acute kidney injury and norepinephrine use following cardiac surgery: a retrospective propensity score-weighted analysis
title_full_unstemmed Association between acute kidney injury and norepinephrine use following cardiac surgery: a retrospective propensity score-weighted analysis
title_short Association between acute kidney injury and norepinephrine use following cardiac surgery: a retrospective propensity score-weighted analysis
title_sort association between acute kidney injury and norepinephrine use following cardiac surgery: a retrospective propensity score-weighted analysis
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9250911/
https://www.ncbi.nlm.nih.gov/pubmed/35781575
http://dx.doi.org/10.1186/s13613-022-01037-1
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